In order to develop strategies, instruments, and programs designed to facilitate
self-disclosure and the cultivation of healthy relationships for victims of childhood
sexual abuse, an understanding of the nature of the crime; our society's perception
of the crime; the nature of the victim's experience and the interpersonal impact
of their victimization; and the relationship of sexual abuse, communication, and
intimacy is gleaned from the literature. Finally, the importance of establishing
healthy internal and external communication habits and a review of formal and informal
therapeutic techniques are presented.

THE NATURE OF CHILD SEXUAL ABUSE

Defining Child Sexual Abuse

Engel (8) states that child sexual abuse "includes any action
on the part of an adult or an older child toward a child that is intended to sexually
stimulate either the older person or the child." Based on this definition, it can
be seen that sexual abuse encompasses a much broader spectrum of behaviors than
often considered to be characteristic. Some behaviors that many interpret as normal
or acceptable are classified as abuse solely on the basis of intent. For example,
Schultz (155) and Engel (13) both state
that nudity in the home in and of itself is not abuse, but, as Schultz
(155) puts it, "nudity with the intent of adult gratification or intimidation
of the child" is abusive. There is disagreement in the literature on the range of
behaviors that are classified as sexual abuse. Included in both Engel's and Schultz'
lists of sexually abusive behaviors, which are representative of much of the literature,
are exhibitionism, nudity, disrobing, genital exposure outside of household privacy
norms that affords the adult sexual gratification; voyeurism or observation of the
child, such as watching a child undress, bathe, or use the bathroom inappropriately
(out of the range of appropriate monitoring of a child); "kissing, in which the
adult gives the child lingering or intimate kisses, especially on the mouth and
perhaps with the adult's tongue stuck in the child's mouth;" "fondling, in which
an offender touches, caresses, or rubs a child's genitals or breasts, or has the
child similarly touch his/her body; rubbing a child's back, head, or other `nonsexual'
part of the body if its intent is to engage the child in a situation that will lead
to actual sexual behavior," including masturbation; "fellatio or cunnilingus, in
which an adult forces a child to have oral-genital contact with him/her or in which
the child is forced to submit to oral-genital sex performed by the adult;" and vaginal
or anal penetration with a finger, penis, or object.

Engel (13-14) expands the list of behaviors to include some
of the more covert forms of sexual abuse, as well as another blatantly physical
behavior. These behaviors that are not universally specified in the literature as
abuse are approach behavior or covert sexual abuse in which the
adult makes direct or indirect sexual suggestions to the child, including sexual
looks, innuendos, and suggestive gestures; inappropriate emotional sexual bonding
by an adult with a child, often as the result of marital dysfunction (This use of
a child to meet adult emotional needs is easily sexualized and romanticized.); exposure
of a child to provocative, sexual language and name-calling, sexual humor, or pornography;
and "dry intercourse" in which the perpetrator rubs his penis between the child's
thighs or buttocks.

The Dynamics of Child Sexual Abuse

The literature makes it clear that, despite its name, sexual abuse is not an expression
of sexuality. Like rape, it is one person's exertion of will on a weaker other.
It is an expression of anger, insecurity, and isolation (Engel 23)
. It is a manipulative, coercive, and aggressive intrusion of an adult or older
child on the mind and body of a young child. In the book, The Sexually Abused Male
, Jim Struve (35) quotes Groth's and Birnbaum's ( Men
Who Rape , 1980) comment on rape, asserting that it pertains equally to
child sexual abuse.

"Rape [or sexual abuse] is a pseudo-sexual act, complex and multi-determined but
addressing issues of hostility (anger) and control (power) more than passion (sexuality).
To regard rape [or sexual abuse] as an expression of sexual desire is not only an
inaccurate notion but also an insidious assumption, for it results in the shifting
of the responsibility for the offence [sic] in large part from the offender to the
victim."

Sexual abuse often is a repeating pattern (Engel 17 ). Many
children who are abused grow up to be abusers. There is generally a history of abuse
and neglect in the childhood of an abuser. A victim's expression of deep-seated
anger as a result of abuse often takes the form of repeating the abusive behaviors
to which he/she was subjected. Males are more likely to become abusers as a result
of their own abuse than are females because of the added dimensions of homosexuality
(the majority of abusers are male) and the social pressure to be a dominator/aggressor
instead of a victim. These attributes can cause the male victim to identify with
the abuser instead of other victims; subsequently, he may express his identification
as hostility, antisocial behavior, and abusiveness (Schetky 48
; Engel 22 ).

The Incidence Rate of Child Sexual Abuse

Sexual abuse is pervasive in its practice within our society. Estimates of the number
of people affected vary widely, owing, in part, to the personal and compromising
nature of the crime. Yudkin (246) cites recent studies that
indicate that about one-third of American females are abused before the age of eighteen.
Therapist, Beverly Engel (xiii) cites experts that believe
that 50 percent of American women are sexually abused as children. Lewis (study
in 1985), using a random nationwide sample of 1,374 women found that 27 percent
of them had been sexually abused (Jehu 3 ). Russell (studies
in 1983, 1986) reports that 50 percent of her sample of 930 California women had
been victims (Jehu 4 ). Wyatt's survey of 248 women in the Los
Angeles area showed an incidence rate of 55 percent (Jehu 4
). It is expected that differences in the reported incidence rates can be attributed
to (1) the reluctance to report abuse, (2) the varying concepts of what behaviors
are considered to be abusive (Wyatt and Peters, 1986, p. 238 in Urquiza and Keating
92 ), (3) factors such as education levels, socioeconomic
status, geographic location, etc., and (4) methodological differences in the studies,
such as sample choice and method of administering the survey instrument (Jehu 5-7 ).

SOCIETAL PERCEPTIONS OF CHILD SEXUAL ABUSE

Long a taboo for open discussion, sexual abuse is cloaked in social stigma and mythology.
Misconceptions abound, unchallenged by the light of truth. From the mechanics of
its perpetration to the intensity of its effects, the general population is unaware
of what this interpersonal cancer does to the lives of its adult survivors and those
who love them.

Most people believe that the perpetrators of sexual abuse are male strangers; however,
in three-quarters of cases, "the culprit was not the candy-offering stranger we
were all taught to fear, but an adult the child knew and trusted" (Yudkin
246 ). "An estimated 90 percent of sexual abuse is at home or at the hands
of someone known to the family. The majority of perpetrators are relatives, most
notably fathers, stepfathers, uncles, grandfathers, older siblings, as well as mothers,
grandmothers, and aunts" (Engel 22-23 ). Other female abusers
might include older cousins, babysitters, older girls in the neighborhood, and female
teachers and coaches (Engel 16 ).

While it is popularly believed that far more girls are sexually abused than boys,
current research estimates show that one in every three children (including boys)
is abused (Engel 19 ). This belief is perpetuated by the fact
that many more girls report incidents of abuse, because the boys are victim to social
stigmatization due to the great possibility that their abuse was at the hands of
another male. Another force that impedes the reporting of abuse by boys is the social
trivialization of their experience. When a boy is abused, he is revictimized by
his culture and by himself because of the expectation that he should be able to
defend himself (Engel 19 ). There is the tendency in our culture
to empathize with female victims but to believe that a boy is not affected much
by an abusive experience; he is expected to be able to "tough out" the emotional
fallout. Romanticization also trivializes the boy's experience (Engel
21 ). He is seen as having a "head start" in his sexual life, something
our society believes every young male wants. Consider the popularity of movies like
The Summer of '42 (Trivelpiece 56 ). What was
romanticized as a young boy's fortunate initiation into sexuality by an older woman
was actually an experience of seduction, emotional manipulation, and physical violation.
Even if a boy chooses to "play the game" of the social stereotype of a sex-hungry
young male, he will suffer emotional consequences that are buried more deeply by
the charade.

Brother/sister sex is often viewed as a mutual encounter (Engel 18
). Same-age sibling or peer sexual experimentation are normal events that, handled
calmly and used as an opportunity for education by any adults who may discover it,
can be harmless. However, the brother/sister abusive encounter "most often occurs
when an older sibling coerces, threatens, or forces a younger sibling into sexual
acts that the younger child is ill equipped to handle." If there is an inequality
of power, there is abuse (Engel 18 ).

Misperceptions of degree are also responsible for the trivialization of abusive
experiences. The belief that "there is no problem if it only happens once" is grossly
insensitive to the effect that such a highly charged emotional and physical experience
can have on a child who does not have the developmental sophistication to place
the act in proper perspective, recognizing the deviance of the perpetrator and absolving
him-/herself of all guilt (Engel 14 ). An equally obtuse evaluation
of inappropriate advances toward a child is that "if there is no penetration, there
is no abuse" (Engel 12 ). Regardless of the act(s) performed
or the number of times the violation takes place, the physical and emotional violation
of child sexual abuse has lasting effects on its victims. "Sexual abuse is the most
shaming of all abuse. It takes less sexual abuse than any other form of abuse to
produce shame" (Bradswhaw 48 ).

THE EXPERIENCE AND EFFECTS OF CHILD SEXUAL ABUSE

Schetky (38-41) focuses on contradictions in many of the
widely cited studies concerning whether or not variances in effects between sexual
abuse victims are the results of variables of incident-specific demography, behavior,
and surrounding psychological climate. These factors include the age of the victim
and the age difference between the victim and the perpetrator; the sex of both the
victim and the perpetrator; the degree of violence involved in the abuse, as well
as the type of abusive acts perpetrated; the relation of the perpetrator; and the
victim's family support system.

Regardless of the interplay of these factors, the assault of child sexual abuse
affects victims across all levels of their lives. They are often physically damaged
and sexually stunted, and their relational capacities are thwarted by a host of
fears and misconceptions seen only through the dark glass of their victimization.
Schetky (49) states "the development of diverse symptoms
may help the child accommodate to this dysfunctional environment while she is trapped
within it. However, as noted, too often this symptomatic adaptation persists into
adult life, rendering the victim dysfunctional."

Schetky (47-48) illustrates that the issue of traumatization
is important to the understanding of the complexity of the adaptive behaviors of
childhood sexual abuse victims. Many studies have drawn parallels between sexual
abuse victims and those who suffer from posttraumatic stress disorder, an affliction
that plagues many Viet Nam war veterans (Goodwin 62 ; Blume
78-80 ; Schetky 43 ).

Stewart (4) states that "interpersonal communication can
happen between [people] when each of [them] makes available some of what makes [them]
persons and when each is aware of some of what makes the other a person too." He
defines intimacy as "a process in which [people] attempt to get close to [each other];
to explore similarities (and differences) in the ways [they] both think, feel, and
behave" (Stewart 25 ). This "making available" and "exploration"
require, at the very least, a nominal level of openness and vulnerability on the
part of each person engaged in communication and striving for intimacy. The violation
of both mind and body that survivors have been forced to endure consumes much of
the psychic energy needed to establish personal togetherness and blocks many of
the pathways that can lead them to sharing their lives with others. Intimacy requires
self-awareness, responsibility for one's feelings, and vulnerability-all of which
are very difficult for the . . . survivor (Blume 253 ).

A shroud of betrayal and anger is cast over a boundless range of relationships as
the result of direct or complicit involvement in sexual abuse. Survivors of child
sexual abuse learn at an early stage in life to distance themselves from their emotions
to avoid the pain of what is happening to them. This distancing results in a significant
internal and external communicative isolation of survivors from themselves and others.
Personalities dissociate, repress, even split in response to the violation of trust,
shame, fear, and self-blame that are the daily internal reality for sexual abuse
survivors. Self may become separated from the body, the emotions, the experience
of childhood, even from other internal selves who are conceived of the trauma (Schetky
42-45 ; Engel 15 ; Yudkin
248 ). The bonds between self and other that may have existed or might have
formed are severely damaged if not lost completely. These manifestations of and
adaptations to the trauma of childhood sexual abuse often result in obtrusive personality
characteristics that inhibit social interaction and self-disclosure, consequently
seriously restricting communication and the formation of intimate relationships.

Numerous studies have found that survivors have significantly higher levels of difficulty
forming and maintaining intimate relationships than their nonabused counterparts
(Ratican 33 ). "Because [survivors] perceive the entire external
world as dangerous and overwhelming, they do not have the autonomy to move toward
new objects, and determinedly avoid significant relationships" (Schultz
148 ). The insidiousness of many sexually abusive behaviors, added to the
already covert and repressed nature of the problem, compounds the difficulty of
gauging its depth and readily identifying the dynamics of the interplay between
the psychology of the abused and his or her style and level of success in the communication
process and intimate relationships.

Many survivors help others to the point of not taking care of themselves (Engel
15 ), and they have difficulty communicating their desires,
thoughts, and feelings to others (Engel 15 ; Bass
27 ; Bass 191 ; Yudkin 249 ; Ratican
35-36 ). Despite the possibility that survivors may be selfless
"helpers," at the same time, they may have difficulty being empathic (Engel
15 ).

Many survivors have difficulty with (Engel 15 ) and feel victimized
by authority. This type of relational conflict, as well as many other factors, may
induce anger/rage outbursts and/or mood swings (Engel 16 )
in a surviving sexual child abuse victim.

"Sexual abuse causes children [and, subsequently, adults] to feel like `damaged
goods' (Urquiza and Capra 108 ). They feel dirty, evil,
and rotten," (Engel 12 ) worthy of no one's love and deserving
of and expecting rejection (Engel 11 ). The survivor's self-esteem
and self-image are likely to be distorted, causing further damage to relational
functioning. Many have reported feeling ugly, worthless, and stupid. They
see themselves as failures, losers, and they constantly sabotage their success in
all areas of life (Engel 15 ). A tendency towards self-blame,
shame, and self-denigration (Engel 12,15 ; Jehu
107-108 ; Schultz 146 ; Bradswhaw 48
; Ratican 34 ) often manifests itself in survivors
repeatedly becoming involved with destructive, abusive people (Engel
15 ; Jehu 137 ). Repeated failures in relationships
spawn a cycle in which victims turn their anger (deserved by the perpetrator) towards
themselves (Engel 11 ), heaping more fuel on the fires of their
self-defeating anger.

Affected Sexual Intimacy

Abuse survivors' potential for enjoyable sexuality is twisted when the perpetrator
robs them of their innocence - "introducing them to adult sexuality before they
are capable of coping with it" (Engel 11 ). As children,
they are prone to eroticization, causing them to act inappropriately sexual with
their peers and adults (Schetky 41-45 ). This may carry over
into sexual promiscuity in adolescence and adulthood. Sex can become "compulsive
as a self-destructive behavior, a means of releasing anger, or a bargaining chip
to obtain attention, money, or security (Ratican 34-35 ).
As reported by Engel (15) , other sexual maladies of which
survivors may suffer are lack of sexual desire and/or enjoyment; sexual dysfunction
(anorgasmic, impotent, premature ejaculation); attraction to illicit sexual activities;
anger/disgust at public affection, sexuality, nudity or partial nudity; the tendency
to be sexually manipulative; and addiction to sexual activities (including pornography).

Keystone Inhibitors of Communications and Intimacy

Engel (60) states that sexual abuse is probably the most emotionally
loaded inhibitor to communications and the surrounding atmosphere of trust and equality
that must exist for intimacy to occur. Amid the psychological aberrations of the
survivor's world are two key concepts whose mixture acts as a formidable barrier
to successful interpersonal communication and, therefore, intimacy. These bywords
for the unconscious dysfunction of the survivor of sexual abuse are trust
and secrecy .

The Violation of Trust

The building blocks of intimacy-giving and receiving, trusting and being trustworthy-are
learned in childhood. If [a child] was abused, [his/her] natural trust was skewed
by adults who misused [his/her] innocence. [They] grew up with confusing messages
about the relationship between sex and love, trust, and betrayal (Bass
36,191 ).

If the abuser was a member of the child's family, a boundary was crossed and a significant
bond of trust was broken. Ellen Ziskind, a Brookline, Massachusetts psychotherapist
states that, "Without basic trust, you can't have good relationships, you have no
self-esteem." (in Yudkin 247 ). Some experts assert that sexual
victimization by teachers, therapists, and doctors, as well as that by fathers,
grandfathers, and uncles, involves the same disastrous betrayal of trust as if the
abuser were a member of the family (Yudkin 247 ).

"Survivors have trouble trusting others appropriately and generally have a poor
sense of personal boundaries. They may trust too readily, setting themselves up
for further abuse, or they may fear intimacy, hold others at arm's length, and become
controlling in relationships. They may use hostility to protect themselves from
expected rejection by rejecting others first. Survivors may suffer from a conflict
between craving intimacy and dependency but needing to control and manipulate to
feel safe in relationships" (Ratican 34 ).

"The Secret"

Denial, repression, guilt, and shame may inhibit the survivors' disclosure of, not
only anything related to abuse, but also details about any aspect of their lives.
Admonitions by the abuser or others to keep the abuse secret may continue to operate
unconsciously in the adult survivor. Past attempts to disclose the abuse to parents,
professionals, or other persons in authority may have met with dismissal or overreaction,
such as punishment or removal from the home (Ratican 35 ;
Schultz 140 ; Bass 92 ). Our society
is often guilty of dismissing children when they tell about abuse, because of an
inherent need to believe that "`nice men,' especially fathers, don't rape children"
(Yudkin 247 ). Stewart (39) notes
that, paradoxically, "Communication is as often a matter of hiding or protecting
what is in [peoples'] minds as it is a matter of revealing their thoughts and intentions."

"Maintaining the secret surrounding the incest [or other form of sexual abuse] contributes
to the [survivor's] avoidance of relationships outside the family" [O'Brien's study
(1987) reported in Schultz 148 ]. The secret is at the center
of the nightmare of child sexual abuse. Blume (61) states,
"Either the incest perpetrator is emotionally and physically necessary for the victim's
survival, or he can influence those who are. Thus he can build walls around her.
The secret completes the trap."

A child, who has limited understanding of the stability of her environment and no
understanding of death, senses that a disruption of the world that supports her
will bring about a darkness and emptiness (abandonment) in which it does not seem
possible that she will survive. Manipulation of this fear is the weapon of the perpetrator.
The child's choice is between sex with the perpetrator or what surely must be "death"
(Blume 61-64 ).

Even outside the victim's home and family surroundings, the secret must be kept.
A natural consequence of the strategies to "keep this skeleton in the closet" is
that "the incest victim withdraws from peers as a defense against her fear of disclosure
of the secret" (Schultz 148 ).

When the survivor speaks, she monitors and selects her words carefully, protecting
the secret that, by now, she may have completely lost conscious contact with. Nevertheless,
she automatically continues to turn others' eyes away from the darkness inside her.
This hypervigilance and its accompanying internal monologue make it impossible for
her to reveal herself in relationships. "And how superficial, then, must her relationships
remain when she becomes so personally withholding" (Blume 67
). "While avoiding intimacy keeps you safe-and sometimes leads to positive traits
such as independence and autonomy-it also means missing out on the rewards that
healthy relationships can bring" (Bass 52 ).

The secret is still a prominent mental/emotional influence when a survivor seeks
counseling, and the survivor may fear that when disclosure does occur, the information
will not be believed or that it might overwhelm the therapist (Ratican
35 ). Psychotherapist Shirley Katz tells how, often, the one-on-one interaction
with an unequal power (therapist and patient) in a secret place (therapist's office)
seems like revictimization to the survivor (in Yudkin 249
).

Internal Dynamics

Much of the communication that goes on in a survivor's life is a fearful, anxious,
angry internal monologue. "[William] Howell emphasizes that internal monologue can
act like a `power disc brake on internal and external adjustment to changing events'
in the present. Our abilities to cope with change can be seriously undermined by
internal monologue" (Stewart 127 ). Internal monologue hits
the brakes, the wheels lock, and adjustment to [an]other person and to events stops
(Stewart 131 ). There is a powerfully distracting covert
force in emotionally charged internal monologue. "When any emotion is active, people
behave differently than when they are unemotional" (Stewart 133
). Threatening situations produce highly distracting thoughts, and fright distorts
the perception of personal interactions. An angry internal monologue exaggerates
emotions, often causing people to say and do things they later regret (Stewart 133 ). This frenzy of mental and emotional activity makes
it difficult for survivors to live in the "here and now," because they are occupied
dealing with either direct or indirect manifestations of their abusive pasts.

A significant issue that must be considered by those who are close to a survivor
(prosurvivors) working toward recovery is the ease with which the survivor's tenuous
steps out of him-/herself can become a harried retreat if he/she senses a drop in
the prosurvivors' support. The survivor is already in a persistent state of self-doubt.
If a prosurvivor intimates disbelief of the survivor's experience, it may throw
the survivor into deeper doubt and despair (Engel 25 ).

FACILITATING COMMUNICATION FOR THE SEXUAL ABUSE SURVIVOR

Stewart (22) purports that "the quality of each person's
life is directly linked to the quality of communication he or she experiences."
Walled in by secrecy and fear, the survivor does not have promising future of enjoying
quality and communication. Blume (72-73) emphasizes that "breaking
the secret through remembering is the necessary first step. Telling someone, the
next. She [the survivor] must [then] face the reality that she holds information
whose withholding keeps others at risk. No perpetrator stops on his own. In breaking
the secret, she has, finally, the power to break the chain." The fetters that have
kept her from intimacy are broken as well.

It's OK To Tell
Bad Touch?
It's OK to tell

It wasn't your fault
You're not to blame
The shame was never yours

Speak out . . .
Don't be afraid

Break the cycle of abuse
Free your heart to trust
Take back your life

It's all right, really . . .

Tell someone

- Boysen (1993)

The act of sharing feelings and details of the abuse experiences in whatever medium
the survivor is comfortable is the training ground for building open communication
habits that can apply to any issue (Faller 374 ). Survivors
are empowered through the channels of communication that they are able to establish
within themselves and with others.

Margot Silk Forrest (1993) asserts that societal desensitization to the "untouchable"
subject of child sexual abuse and public education concerning the interpersonal
ramifications of this experience are necessary elements in an overall program to
open communication channels between victims and other victims and between victims
and those who love them.

Techniques for Communicating

In recovery, channels of communication that have been successful in establishing
contact with the world outside of the survivors' internal struggle are stream-of-consciousness
writing, journal keeping and subsequent reading of this writing to individuals or
a group in a therapeutic (professional or personal) setting, letter writing, writing
poetry, and the dyadic and group therapeutic experiences. These expressions afford
the opportunity for survivors to sort out feelings and facts that are internally
distorted, to become desensitized to their experience by repetition, to grieve,
to make real what may have been denied or trivialized, and to establish contact
with others who have experienced a like trauma.

Writing

The object of this communication channel is to write about being sexually abused
as a child. Most survivors have had their experiences denied, trivialized, or distorted
repeatedly. Writing gives them the opportunity to define their own reality. They
often access and reexperience feelings, and, as an adult, they are able to grieve
for what, as a child, they were not equipped to process (Bass 27
). An advantage to writing is that it is possible to do just about anytime and anywhere.

Stream-of-Consciousness, Journaling, and Letter Writing

In stream-of-consciousness writing, the writer is advised to ignore formality, such
as punctuation, complete sentences, etc., making it easier to open the mind and
let thoughts and feelings out that might otherwise be censored (Bass
28-9 ). This form of writing is especially suited for journaling. Bass
(27) asserts that "expressing a free flow of thoughts can help [survivors]
figure out how [they] feel, what [they] think, what [they] need, what [they] want
to say, how [they] want to handle situations, just by writing it through."

Reading this writing to a responsive, supportive listener will help the words come
to life, affirming the reality of an abusive past that has been buried under defensive
maneuvers and rituals. If the survivor cannot find anyone to read to right away,
he/she can read out loud while alone. At least there will be one attentive listener,
and just saying the words out loud can make them more real (Bass 28
).

Letter writing is another communication channel that can be used to help survivors
get in touch with and express blocked feelings (Ratican 36
). Blume (292) stresses that letters written to significant
persons, such as parents, the abuser(s), or siblings are an especially effective
medium through which survivors can face and unload feelings. The letters do not
even have to be mailed to be an effective tool. The letters that do not get mailed
are often the most honest expressions of repressed feelings. The other person's
response does not necessarily have to be a factor in this exercise (Blume
293 ).

A special class of letters are those written to "the child within," the child who
lived through an abusive childhood and is very much alive and still feeling the
pain and fear of the past. This can be a valuable experience whether or not the
survivor believes that the child exists. The survivor can, at least by acting, become
a parent to the child (Bass 115 ), and help him/her by validating
the feelings of betrayal that were suppressed in order to survive (Bass
191 ).

Writing Poetry

My poetry is, or should be, useful to me for one reason: it is the record of my
individual struggle from darkness towards some measure of light . . . My poetry
is, or should be, useful to others for its individual recording of that same struggle
with which they are necessarily acquainted . . . Poetry recording the stripping
of the individual darkness, must inevitably cast light upon what has been hidden
for too long, and, by doing so, make clear the naked exposure (Poet Robert Graves
in Morrison 20-30 )

Leedy (20) states that "in all cases, the goal of psychotherapy
is to bring about a more mature integration of personality." Poetry also serves
this integrative purpose. Poetry and psychotherapy both contain unconscious and
preconscious components, such as dreams, daydreams, and fantasies. "Both employ
the defense mechanisms of condensation, sublimation, displacement, and symbolization."
The poet offers his/her insights and struggles to the reader who vicariously lives
out these emotions. Poetry written by survivors can be a therapeutic tool for stimulating
personal insight in themselves and other survivors (Morrison 29
). Molly Harrower, professor of psychology, writes, "Poetry is therapy . . the
very act of creating is a self-sustaining experience, and in the poetic moment,
the self becomes both the ministering `therapist' and the comforted `patient'" (Morrison
36 ).

The following reassuring statement made by Christopher Caudwell in Illusion and
Reality, A Study of the Sources of Poetry (International Publishers, 1970,
p. 230 ) may be an anchor for the survivor who practices
emotional release through poetry, a practice that can become very intense and sometimes
frightening.

Although there is a correspondence between artistic and schizophrenic solutions
. . . the goal is, in fact, the opposite. As compared with existing normality, the
mad road leads to greater illusion, unconsciousness, and privacy, the scientific
or artistic road leads to greater reality, consciousness, and publicity (in Morrison
36-37 ).

Individual and Group Interaction

[She] was justifiably proud of the fact that she learned to be "a perfect lady"
in even the most impossible of circumstances. Her voice was always calm, her emotions
in control. She took pride in not ever needing anyone for anything. Her only problem
was that she didn't have a single friend in whom to confide (Stewart
217 ).

Initial communication during recovery is often explosive anger at the perpetrator
or a silent-partner parent. This may cause constant and often inappropriate conflicts
with others (Engel 26 ). It would serve well for the survivor
to alert potential confidants to this fact. Regardless of the dynamics of the interaction,
communication must be established with others for the survivor to heal.

Widespread and frequent relating of their story makes the repressed experience real
for them, and they are finally able to experience the related emotions (Engel 37 ). This is the essence of breaking the hold that a childhood
of sexual abuse has on the adult survivor. This is telling the secret .

Bass (98) delineates a process she calls the Levels of Telling
. Step one is telling and not feeling. Saying "I" but not really owning the
experience. Still disbelieving. Step two is the hurting child who is in touch with
the pain. There is an accompanying "regressive" feeling (even some speech may be
childlike). At this stage, the story is often told to persons in caretaking positions.
Step three is telling the whole story. At this point the survivor becomes aware
of the dynamics of what happened in the past and, perhaps, why it happened. This
step involves relating the story in an "understanding" context without intellectualizing.

Therapeutic Interaction

Though much can be done by survivors on their own, they must recognize that the
feeling of not needing anyone is a part of the legacy of their past. It is imperative
that they become involved with individuals as personal confidants as well as with
a therapist and/or therapy group.

Individual therapy affords survivors the opportunity to bare their pasts in a private
setting. As mentioned earlier, this can be a fearful experience, but, nonetheless
a necessary one. The therapist facilitates the "telling of the secret" through questioning
and listening. Ratican (36) suggests that "empty-chair techniques,
psychodrama, and guided imagery can be used to work through confrontations with
[the] abuser[s] . . .."

Group therapy is a follow-up or adjunct to individual therapy that helps survivors
build their social skills and gain insight into their own abusive experience(s)
through the stories of other survivors. "Spontaneous sharing and confrontation by
other group members is effective at breaking through denial" (Ratican
36 ). Yudkin (249) emphasizes the importance that
group therapy can play in facilitating the survivor's release of anger that can
be directed at other survivors' abusers. "When [survivors] hear other survivors
talk about [their] abuse and are not disgusted, and when [they] see those same survivors
listen to [their] own story with respect, [they] begin to see [themselves] as proud
survivors rather than conspiring victims" (Bass 108 ).

GENERAL EVALUATION OF THE
LITERATURE AND RESEARCH OBSERVATIONS

The literature offers an abundance of information on the forms and nature of the
crime of child sexual abuse, misconceptions about it, and its immediate and lasting
effects on the victims. There is little direct information on its effects on communication,
but much can be inferred from the psychological implications and the nature of the
process of communication. Channels of communication that have proven to be helpful
in the healing process receive some attention in the literature. Clearly, trust
and secrecy emerge as seminal communication issues in the life of sexual abuse victims.

There are no guarantees that any of the treatment methods or communication exercises
mentioned in the literature will be effective in relieving the maladies caused by
childhood sexual abuse. Psychologist Louis Berger (1993) concurs
with Schetky (38-41) that there are many variables that can
affect the degree to which a sexual abuse victim is traumatized. Berger also asserts
that intense psychoanalysis is required to adequately deal with this trauma, and
that unsupervised "attempts" do little to really help the survivor. However, the
literature demonstrates that becoming aware of the inner darkness, examining its
source (cause), shedding light on its existence and effects, and sharing in pain
and support with others who have experienced the same trauma has been a source of
great relief for many. Longitudinal studies of survivors using various healing methodologies
will be helpful in resolving this issue.

OPPORTUNITIES FOR FURTHER STUDY

Goodwin (62) , Blume (78-80) , and Schetky
(43) suggest that childhood sexual abuse causes posttraumatic
stress disorder (PSD), a diagnosis that elevates the possible psychological effects
to a level much higher than those produced by other forms of violence. Therapist,
Martha Moses (1993) stresses the importance of this distinction
of the nature childhood sexual abuse in treatment considerations. A study of the
literature on PSD in Viet Nam veterans and a subsequent correlation of its effects
and the treatment programs in current use might aid in the treatment of childhood
sexual abuse survivors.

A question that is unanswered in the literature is: "What motivates a victim to
become a survivor?" Answers to this question must be sought so that the communication
tools presented in the literature review and those yet to be discovered can be made
available to victims, psychologically "packaged" so that reluctant victims are more
likely to use them.